Wisconsin Administrative Code

Ins 52.07 Applicability. (1) This subchapter applies to determine whether credit may be taken for: (a) Any reinsurance ceded under agreements entered into on or after August 1, 1993; or (b) Any reinsurance ceded if the reinsurance agreement is renewed by agreement on or after Aug…

Ins 52.20 Purpose, intent, and applicability. In addition to provisions contained at s. Ins 2.80, the following apply to this subchapter: (1) PURPOSE AND INTENT. The purpose and intent of this subchapter is to establish uniform, national standards governing reserve financing arra…

Ins 52.21 Exemptions. This subchapter does not apply to the situations described below: (1) Reinsurance of: Ins 52.21 (a) Policies that satisfy the criteria for exemption set forth in s. Ins 2.80 (5) (k) or (L) that were issued prior to June 1, 2022. (b) Portions of policies that…

Ins 52.22 Definitions. In this subchapter, unless the context otherwise requires: (1) XActuarial methodY means the methodology used to determine the required level of primary security. (2) XCovered policiesY means the following: subject to the exemptions described in s. Ins 52.21…

Ins 52.23 Actuarial method. (1) ACTUARIAL METHOD. The actuarial method to establish the required level of primary security for each reinsurance treaty subject to this regulation shall be VM-20, applied on a treaty-by-treaty basis, including all relevant definitions, from the valu…

Ins 52.24 Requirements applicable to covered policies to obtain credit for reinsurance: opportunity for remediation. (1) REQUIREMENTS. Subject to the exemptions in s. Ins 52.21 and sub. (2), credit for reinsurance shall be allowed with respect to ceded liabilities pertaining to c…

Ins 52.25 Severability. If a provision of this regulation is held invalid, the remainder shall not be affected.

Ins 52.26 Prohibition against avoidance. No insurer that has covered policies as to which this subchapter applies, as set forth in s. Ins 52.20 (2), shall take any action or series of actions or enter into any transaction or arrangement or series of transactions or arrangements i…

Ins 53.01 Purpose. The purpose of these regulations is to set forth the procedures for filing, and the required contents of, the corporate governance annual disclosure, deemed necessary by the commissioner to carry out the provisions of s. 610.80, Stats.

Ins 53.02 Definitions. In addition to definitions contained in s. 610.80 (1), Stats., the following definitions shall apply in this chapter: (1) XCommissionerY means the Wisconsin insurance commissioner. (2) XInsurance groupY means those insurers and affiliates included within an…

Ins 53.03 Filing procedures. Each year following the initial filing of the corporate governance annual disclosure, the insurer or insurance group shall file an amended version of the previously filed disclosure indicating where changes have been made. If no changes were made in t…

Ins 53.04 Contents of the corporate governance annual disclosure. (1) The insurer or insurance group shall be as descriptive as possible in completing the corporate governance annual disclosure, with inclusion of attachments or example documents that are used in the governance pr…

Ins 55.01 Scope. (1) This chapter applies only to: (a) Domestic life and accident and health insurers; (b) Licensed life and accident and health insurers which are not subject to a substantially similar rule or law in their state of domicile; and (c) Licensed property and casualt…

Ins 55.02 Accounting requirements. (1) No insurer may, for reinsurance ceded, reduce any liability or establish any asset in any financial statement filed with the office of the commissioner of insurance if, by the terms of the reinsurance agreement, in substance or effect, any o…

Ins 55.03 Written agreements. An insurer may not reduce any liability or establish any asset in any financial statement filed with the office of the commissioner of insurance, based on a reinsurance agreement or amendment to any agreement unless: (1) The agreement, amendment or a…

Ins 55.04 Effect of failure to comply. No insurer may reduce any liability or establish or maintain an asset for the purpose of determining whether the insurer is in financially hazardous condition, establishing or representing the financial condition of the insurer, or for the p…

Ins 55.05 Applicability. (1) This chapter applies to reinsurance agreements entered into prior to, on or after its effective date. (2) An insurer shall reduce to zero by December 31, 1994, the chapter was last published. 3 COMMISSIONER OF INSURANCE any reserve credits or assets e…

Ins 57.01 Definitions. In addition to the definitions in s. 648.01, Stats., in this chapter: (1) XAffiliateY of, or person XaffiliatedY with, a specific person means a person that directly or indirectly through one or more intermediaries, controls or is controlled by, or is under…

Ins 57.04 Financial requirements. All of the following are the minimum financial requirements for compliance with this section unless a different amount is ordered by the commissioner, after consultation with the department: (1) WORKING CAPITAL. Unless otherwise ordered by the co…

Ins 57.05 Business plan. All applications for permits of a care management organization shall include a proposed business plan. In addition to the items listed in s. 648.05 (2), Stats., the following information shall be contained in the business plan: (1) ORGANIZATIONAL INFORMAT…

Ins 57.06 Changes in the business plan. A care management organization shall file a written report of any proposed substantial change in its business plan. The care management organization shall file the report at least 30 days prior to the effective date of the change. The offic…

Ins 57.07 Copies of provider agreements. (1) Notwithstanding any claim of trade secret or proprietary information, all care management organizations shall, upon request, from the commissioner, make available to the commissioner all executed copies of any provider agreements betwe…

Ins 57.10 Acquisition of control of or merger with a care management organization. (1) FILING REQUIREMENTS. (a) No person other than the care management organization may enter into an agreement to merge with or otherwise to acquire or attempt to acquire control of a care manageme…

Ins 57.12 Standards for transactions within a holding company system. (1) TRANSACTIONS WITHIN A HOLDING COMPANY SYSTEM. A care management organization or affiliate of a care management organization may not enter directly or indirectly into a transaction between the care managemen…

Ins 57.13 Privileged information. The information required to be filed with the commissioner under s. Ins 57.10 is required under s. 601.42, Stats., and the commissioner may keep it confidential as provided under s. 601.465, Stats. History: EmR0927: emerg. cr. eff. 10-10-09; CR 0…

Ins 57.20 Forms and Instructions. (1) GENERAL. Forms A and B contained in Appendix 1 to this chapter are intended to be guides in the preparation of the statements required by this chapter. They are not intended to be blank forms which are to be filled in. The statements filed sh…

Ins 57.22 Forms — incorporation by reference, summaries and omissions. (1) INCORPORATION BY REFERENCE. Information required by any item of forms A, B or C contained at Appendix 1, may be incorporated by reference in answer or partial answer to any other item. Information containe…

Ins 57.23 Transactions subject to prior notice — notice filing. A person required to give notice of a proposed transaction under this chapter shall furnish the required information in substantially similar in format and in response to questions presented on form B in Appendix 1. …

Ins 57.24 Dividends and other distributions. Requests for approval of dividends or any other distributions to shareholders or corporate members shall include the following: (1) The amount of the proposed dividend or distribution; (2) The date established for payment of the divide…

Ins 57.25 Consent to jurisdiction. Any person required to file consent to jurisdiction under s. 648.45 (3), Stats., shall do so in a format substantially similar to the format and questions contained in form C of Appendix 1 to this chapter. History: EmR0927: emerg. cr. eff. 10-10…

Ins 57.26 General requirements related to filing and extensions for filing of annual audited financial reports. (1) A care management organization shall: (a) Annually obtain or cause an audit of the care management organization by an independent certified public accountant; and (…

Ins 57.30 Contents of annual audited financial report. The annual audited financial report required under s. Ins 57.26 shall comply with all of the following: (1) Report the financial position of the care management organization as of the end of the most recent calendar year and …

Ins 57.31 Designation of independent certified public accountant. (1) A care management organization shall, within 60 days after the care management organization becomes subject to this subchapter: (a) Provide the commissioner in writing the name and address of the independent ce…

Ins 57.32 Qualifications of independent certified public accountants. (1) The commissioner may rule that an accountant or accounting firm is not qualified for purposes of expressing an opinion on the financial statements in the annual audited financial report required under this …

Ins 57.33 Scope of audit and report of independent certified public accountant. Financial statements furnished under s. Ins 57.30 shall be audited by the independent certified public accountant. The independent certified public accountant shall conduct the audit of the care manag…

Ins 57.35 Notification of adverse financial condition. (1) A care management organization shall require the independent certified public accountant to report, in writing and within 5 business days, to the board of directors of the care management organization or its audit committ…

Ins 57.38 Availability and maintenance of CPA work papers. (1) A care management organization shall require the accountant or accounting firm which conducts an audit or other procedure under this subchapter to make available for review by the commissioner all work papers and any …

Ins 57.39 Conduct of care management organization in connection with the preparation of required reports and documents. (1) No director or officer of a care management organization may, directly or indirectly: (a) Make or cause to be made a materially false or misleading statemen…

Ins 57.40 Care management organizations to file financial statements. A care management organization shall file annual and quarterly financial statements with the commissioner. A care management organization shall file the financial statements in a format determined by the commis…

Ins 57.41 Exemptions and effective dates. (1) The commissioner may grant an exemption from compliance with s. Ins 57.26 if the commissioner finds that compliance would constitute a financial or organizational hardship upon the care management organization, except as provided in s…

Ins 6.01 Foreign company to operate 2 years before admission. Experience has demonstrated that until a company has engaged in the business of insurance for at least 2 years there is not a sufficient basis upon which to form a judgment as to whether its methods and practices in th…

Ins 6.02 Company to transact a kind of insurance 2 years before admission. (1) Experience has demonstrated that until a company has engaged in a kind of insurance or in another kind of insurance of the same class for at least 2 years, there is not a sufficient basis upon which to…

Ins 6.03 Domestication of nondomestic insurer. (1) PURPOSE. Under s. 611.223 (1) (a), Stats., a nondomestic insurer may apply to the commissioner to become a domestic insurer. In accordance with s. 611.223 (1) (b), Stats., this section specifies the contents of the application ne…

Ins 6.05 Filing of insurance forms. (1) PURPOSE. This section interprets and implements ss. 601.42, 631.20, 631.22 and 631.61, Stats. (2) SCOPE. The requirements of this section shall apply to forms subject to s. 631.01, Stats., for the lines of insurance listed in s. Ins 6.75, e…

Ins 6.06 Minimum documentation in support of rate filings. (1) PURPOSE. The purpose of this section is to establish the minimum supplementary rate information required to be submitted with rate filings to the commissioner. Statutes interpreted or implemented by this section are s…

Ins 6.07 Insurance policy language simplification. (1) PURPOSE. The purpose of this rule is to establish minimum standards for legibility, coherence and understandability in consumer insurance policies delivered or issued for delivery in the state of Wisconsin on or after the eff…

Ins 6.08 Claimant representatives. (1) PURPOSE. This section provides limited regulatory guidelines concerning the activities of claimant representatives. This section also protects insurance consumers from practices that the commissioner finds to be unfair trade practices. The c…

Ins 6.09 Prohibited acts by captive agents of lending institutions and others. (1) PURPOSE. This rule implements and interprets applicable statutes, including but not limited to ch. 628, Stats., prohibiting concerted acts of boycott, coercion, or intimidation resulting in or tend…

Ins 6.10 Property and casualty premium restrictions. (1) PURPOSE. This section requires insurers who may return a premium that is less than the pro rata unearned premium to disclose this to the insured. This section also establishes prohibitions concerning specified practices rel…

Ins 6.11 Insurance claim settlement practices. (1) PURPOSE. This rule is to promote the fair and equitable treatment of policyholders, claimants and insurers by defining certain claim adjustment practices which are considered to be unfair methods and practices in the business of …